Video-assisted thoracoscopic lobectomy mitigates adverse oncological effects of delayed adjuvant chemotherapy for nonsmall cell lung cancer patients.

PURPOSE: Delaying adjuvant chemotherapy initiation >8 weeks after radical lobectomy for non-small cell lung cancer (NSCLC) adversely affects overall survival. The effect of video-assisted thoracoscopic lobectomy (VATS) on adjuvant chemotherapy initiation is yet unclear. This study aimed to determine if using VATS for NSCLC resection affected the timing of adjuvant chemotherapy and oncological outcomes.

METHODS: Patients who underwent radical lobectomy for pathological stage II or IIIA NSCLC and received adjuvant chemotherapy between January 2009 and January 2016 were identified from a prospectively maintained lung cancer database. Patients were categorized according to surgical approach: open lobectomy or VATS. Patient demographics, clinicopathological data, postoperative complications, time from radical lobectomy to adjuvant chemotherapy initiation, and long-term survival outcomes were compared.

RESULTS: Age, gender, American Society of Anesthesiologists (ASA) class, comorbidity, TNM stage, and postoperative complications were similar between VATS and open cases; however, length of stay was shorter in VATS cases. No difference was observed in the proportion of patients who received adjuvant chemotherapy >8 weeks after radical lobectomy between the two groups. In the open group, a delay in adjuvant chemotherapy after radical lobectomy was associated with decreased overall survival (OS) and disease-free survival (DFS). However, delay in chemotherapy did not affect OS or DFS in the VATS group.

CONCLUSIONS: The benefits of quicker recovery after VATS did not result in earlier adjuvant chemotherapy initiation in this retrospective study. However, VATS negated the inferior oncologic outcomes associated with delayed adjuvant chemotherapy initiation.